Nicotine Craving!

"It's easy to quit smoking – I've done it a dozen times!" If you can stay off cigarettes right up to when that nicotine craving hits, but then you're reaching frantically for that pack of smokes, Dr. Norman H. Edelman, chief medical officer of the American Lung Association, has some information you'll want.

Getting a grip on withdrawal

You've decided that the rest of your life will be cigarette free – now comes the hard part. Grumpiness, headaches and, worst of all, "nic fits" – strong cigarette cravings – are some of the "quitter's flu" symptoms you may face.

Dr. Norman H. Edelman, chief medical officer of the American Lung Association, explains what to expect during withdrawal.

What is withdrawal?

For a short period after quitting, Edelman says, you'll feel quite uncomfortable, because your body is trying to overcome 2 types of addiction:

physical: Your brain is reacting to the sudden lack of nicotine.

psychological: Your mind is dealing with the end of habit-related rituals, such as smoking after a good meal, or the hand-to-mouth motion.

What are the symptoms?

Edelman says the most common withdrawal symptoms include:

cravings

hunger

trouble sleeping

grumpiness

cough and sore throat

dizziness and headaches

restlessness

difficulty concentrating

fatigue

"Most commonly, people become ill-tempered, restless, and get cigarette cravings," Edelman says.

Does everyone experience withdrawal symptoms?

Most people experience one or more symptoms, depending on the length and severity of their addiction, Edelman says. Some people are not as strongly affected by withdrawal symptoms: "they don't pay attention to them as much, so they aren't as bothered."

How long does withdrawal last?

Irritability and cravings last one to two weeks, Edelman says, while smoking-related habits – "not smoking after sex, not knowing what to do with your hands" – die harder, after several weeks or months.

How can I deal with withdrawal?

Edelman advises following the four D's:

deep breaths: Deep breathing will help you relax and help you deal with cravings.

drink water: Water flushes out toxins and drinking it keeps your hands busy.

distract: Keep your mind off smoking by keeping busy. Walking, reading, or watching movies is ideal. "So is exercise – it's good for your body, keeps you occupied, and gives you a psychological boost," he says.

delay: Convince yourself that, no matter how long your craving, you can wait it out.

How can I keep from giving up?

Sharing your experience with those close to you helps alleviate the stress of your challenge, Edelman says. Also, keep your eyes on the prize, because it's a big one. "You're adding years to your life, decreasing your chances of getting lung or heart disease, improving the health of the people around you," he says. "By quitting smoking, you're greatly enhancing your quality of life."

Give me some nicotine!

Kicking your smoking habit to the curb might be on your to-do list, but how do you turn your good intentions into concrete action?

The market is full of nicotine replacement therapy (NRT) tools that work differently for different types of smokers. Nicotine replacement therapies replace the nicotine you used to get from cigarettes (without the harmful toxins) so that you can focus on the psychological triggers of cravings.

Despite what your best pal might tell you, these products are very effective. But, to increase your chances of success, these products need to be used properly, and your doctor or pharmacist can provide more detailed information.

Meanwhile, Dr. Norman H. Edelman, chief medical officer of the American Lung Association, offers an overview on the range of NRTs.

Nicotine without a trip to the "doc"

Patch
You stick the patch like a bandage anywhere between your neck and waist, and it releases a steady stream of nicotine into your body. The patch can be worn around the clock for up to 10 weeks and, depending on the dose, is a 2- or 3-step process. Gradually you use patches with lower and lower amounts of nicotine, weaning your brain off the desire for a nicotine hit.

The patch is easy to use, and since you gradually reduce the amount of nicotine you have, it helps minimize quitting symptoms such as tenseness, drowsiness, and cravings. On the other hand, during the summer it can be somewhat visible, and it can cause side effects such as skin irritation, dizziness, restlessness, headache and nausea. Some people find that it can affect their sleep, so they remove it during the night. It can also lead to abuse by the user. The patch should be removed about 2 hours before engaging in exercise.

"The constant nicotine dose makes it harder to get off. Look for brands that start with high concentrations and work down to lower ones," Dr. Edelman says.

Lozenge
A lozenge is a hard candy that slowly releases nicotine through the mouth lining as it dissolves. Lozenges come in different strengths and deliver nicotine for about 20 to 30 minutes. Depending on their previous smoking habits, users consume up to 15 per day and slowly decrease the number of lozenges over the course of approximately 12 weeks. It can be used together with the patch to help with breakthrough nicotine cravings.

Lozenges are a discrete and simple-to-use quitting device, Dr. Edelman says, but they can cause sore gums and teeth, indigestion, and throat irritation.

Gum
This chewy tool delivers nicotine to your brain within minutes, thereby significantly reducing the need to smoke. To be effective, learn the proper technique for chewing (bite, bite, park) and use no more than 20 pieces per day and slowly decrease the dose. Similar to the lozenge, it can be used together with the patch. Try quitting within 6 months on this therapy.

The gum is popular among quitters because it's easy and it provides a rush. "It gives smokers that high when they need it," Edelman says.

However, like the patch, it's susceptible to abuse by users. It might also stick to dentures or dental work.

Inhaler
Designed for you to take a puff whenever you have a craving, the inhaler slowly delivers nicotine into the mouth. Users should ingest no more than 16 cartridges per day over 12 weeks.

Like other NRTs, the inhaler provides that coveted smoker's rush and it can help satisfy that hand-to-mouth craving, but, Dr. Edelman says, it's more expensive than other NRTs, and can cause mouth and throat irritation.

Spray
This aerosolized spray is designed to help you reduce cravings. It's a simple-to-use product that sprays a fine mist, containing nicotine, for absorption through your mouth. Users should not use more than 4 sprays every hour. Aim to stop using the spray after 12 weeks.

If your lips come in contact with the mist when you use this product, you may experience tingling lips and hiccups. Also be aware that the spray is fairly strong-tasting because of the nicotine within the sprayer.

Doctor required

Nasal spray
Nicotine nasal spray works like a decongestant spray. It lets the nicotine be absorbed into the bloodstream faster than any other NRT, giving users a nicotine "hit." Use no more than 5 sprays per hour over 8 to 12 weeks.

While the nasal spray provides a rush, Dr. Edelman says, it can also prompt nose and throat irritation.

Other tools

Nicotine-free smoking cessation drugs, such as bupropion (Zyban®) and varenicline (Champix®), are also available and can be prescribed by your doctor or pharmacist. Going cold turkey, Dr. Edelman says, works only for people with nerves of steel.

Bottom line

Dr. Edelman says using NRTs in conjunction with structured help, such as the ALA's Freedom From Smoking program (visit www.lungusa.org for more details) or the Canadian Cancer Society's One Step at a Time program (visit www.cancer.ca for more details), is the most effective way to quit.

"The way to quit smoking is highly personal and different methods work for different people," he says. "What matters most is that you keep trying until you're successful."

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